SAN PABLO

COLLEGES
COLLEGE OF NURSING

a Case Study about

Placenta Previa

Presented by:
Abania, Mary Joyce S.
Deangkinay, Bea C.
Gapaz, Jade Elaine L.
Celino, Aaron N.
Resureccion, Christian Arielle B.

Presented to:
Mr. Ryan Simon Ebalde
 SAN PABLO COLLEGES
COLLEGE OF NURSING
CASE STUDY

ACUTE ALCOHOL INTOXICATION

I. CLINICAL SCENARIO

Mrs. Sarah, 38-year-old pregnant woman who presents to the emergency department with

a complaint of vaginal bleeding. She was conscious prior to transferring into the bed, and had a

series of panic attacks and tachypnea. Upon assessment, the patient is pregnant as evidenced by

her abdominal enlargement. She reports that she experienced spotting a few days ago and now has

experienced more vaginal bleeding. She denies any associated abdominal pain.

II. DEFINITION OF THE DISEASE

A. Placenta Previa

Placenta Previa is a condition during pregnancy related to blockage of the mother’s

vaginal exit whereas the placenta develops in the mother's uterus during pregnancy. The most

common symptom is painless vaginal bleeding in the second half of pregnancy. People with

Placenta Previa typically need an Emergency C-section delivery. There are several types of

Placenta Previa:

Marginal Placenta Previa: The placenta is positioned at the edge of your cervix. It’s touching

your cervix, but not covering it. This type of Placenta Previa is more likely to resolve on its own

before your baby’s due date.

Partial Placenta Previa: The placenta partially covers your cervix.

Complete or total placenta Previa: The placenta is completely covering your cervix, blocking

your vagina. This type of Placenta Previa is less likely to correct itself.

Each type of placenta Previa can cause vaginal bleeding during pregnancy and labor and might

lead to the mother having Cesarean delivery. Placenta Previa occurs in about 1 in 200

pregnancies. Pregnancy care providers usually diagnose it in the second trimester during an

ultrasound. There are several factors that increase your risk for placenta Previa during

pregnancy:

 Low implantation of the fertilized egg

 Abnormalities of the uterine lining, such as fibroids.

 Scarring of the uterine lining (endometrium).

 Abnormalities of the placenta.

 Multiple babies, such as twins.

 Multiple pregnancies - a woman who has already had six or more deliveries has a risk of

one in 20.

In the case of Mrs. Dela Cruz, she is 28 weeks pregnant and has complete or total placenta

previa. A gravida 4 para 3 and had a C-section from her last delivery and had experienced

episodes of vaginal bleeding.

B. Signs and symptoms

The most common symptoms of placenta previa are:

 Bright red bleeding from your vagina. The bleeding often starts near the second half of

pregnancy.

 Mild cramping or contractions in your abdomen, belly or back.

 The amount of vaginal bleeding can vary and is often not accompanied by any pain.
 III. PATHOPHYSIOLOGY

Placenta previa occurs when the placenta implants low in the uterus or migrates into the lower

segment of the uterus due to the upper uterus endometrium not well vascularized thus covering the

internal cervical os. Low vascularization can be caused by damage from previous cesarean,

abortion, uterine surgery, and multiparity. There are also a few risk factors that cause placenta

previa, these include having multiple placentas, placenta larger than normal surface area, maternal

age (35 & above), intrauterine fibroids, and maternal smoking.

 IV. ASSESSMENT

Upon admission Mrs. Dela Cruz is conscious. She is covered with some blood and having

panic attacks as seen in her behavior. She is accompanied with 3 individuals and her abdominal

is large which proves that the patient is pregnant. Mrs. Vasco also stated “Nahihilo ako” upon

entering emergency room.

B. Health History

I. Biographical Data

Name: Mrs. Sarah Co Dela Cruz

Sex: Female

Date of Birthday: February 14, 1985

Age: 38 years old

Present Address: San Gregorio, San Pablo City

Occupation: Housewife

Date of Admission: October 3, 2023

Chief Complaint: Painless Episodes of Vaginal Bleeding

Admitting Diagnosis: Placenta Previa

Final Diagnosis: Placenta Previa

II. History of Present Illness

No history of present illness.

III. Past Medical History

(+) History of Cesarean Delivery, 3rd child

IV. Psychosocial (as observed)

Upon clinical observation, Mrs. Vasco possessed strong family-tie and has a quality support

system from family, helping her to cope up in the patient bed.

D. Physical Assessment

I . Vital Signs

Temperature: 37.6

Pulse Rate: 120

Respiratory Rate: 25

Blood Pressure: 110/90

Oxygen Saturation: 99%

-Skull

 Normocephalic

 No signs of trauma

-Scalp

• Oily

• No scars, lesion, and tenderness.

-Face

• The face is pale

-Hair

• Black in color.

• Thick hair growth.

• no signs of alopecia.

-Ears

• No signs of discharge and obstruction.

-Nose

• No signs of discharge and obstruction.

-Eyes

 The Eye color is brown

 No signs of abnormalities

- Lips and Mouth

• Lips are dry and flaky.

-Skin

 Brown skin

 No signs of edema

 Have small amount of rashes

-Nail

 Clean Nails
  No signs of abnormalities.

V.TREATMENT

Medical Management:
IV Fluid Administration
Laboratory Examination: blood grouping and cross matching
Assessment of blood loss by inspection of blood clots and pads
Bed rest, constant fetal monitoring
Reducing activities and sexual intercourse
Surgical Treatment:
Corticosteroids
Amniocentesis
Cesarean Section
VI.DRUG STUDY

SAN PABLO COLLEGES

COLLEGE OF NURSING

DRUG STUDY

Generic– Contraindications
Classification Patient
Brand and Adverse Nursing Consideration
and Indication Effects Teaching
Name
Betamethasone Classification: Contraindications: Teach client medication’s Systemic
(Celestone Falls into the Situations where purpose and potential side use
category of immediate delivery effects, required monitoring
Soluspan)
Antenatal is needed Avoid
Corticosteroids Confirm gestational age, exposure to
Systemic maternal results of prenatal infections;
Indications: infection gestational diabetes ability to
Typically screening fight
administered Maternal infections
to pregnant chorioamnionitis Administer IM in large is reduced.
individuals at muscle mass; do not
risk of preterm massage Wear a
birth between Precautions: medical
24 and 34 Monitoring: vital signs, alert tag so
weeks of lung sounds, glucose level, emergency
gestation Pregnancy, labor status care
breastfeeding, providers
children, will know
renal/hepatic that you
disease, folic are on this
acid/iron deficiency medication.
anemia, infection.
You may
experience
these side
Adverse Effects: effects:
Negative effects on Increase in
fetal intrauterine appetite,
growth and on weight gain
neonatal birth (counting
weight calories
Increased risk of may help);
early-onset heartburn,
neonatal sepsis. indigestion
(eat
A reduction of fetal frequent
body and breathing small
movements and a meals; take
reduction of fetal antacids);
heart rate variation. muscle
weakness,
fatigue
(frequent
rest periods
will help).

Report
unusual
weight
gain,
swelling of
the
extremities,
muscle
weakness,
black or
tarry
stools,
fever,
prolonged
sore throat,
colds or
other
infections,
worsening
of original
disorder.
 Thiamine Contraindications: Assess: • Anaphylaxis (IV • Teach the
Mononitrate Pharmacologic Hypersensitivity only): swelling of face, necessary
(B1) Category: Precautions: eyes, lips, throat, wheezing foods to be
Nuramine Forte Vitamins B1, Pregnancy • Thiamine deficiency: included
water soluble anorexia, weak- in diet:
Adverse Effects ness/pain, depression, yeast, beef,
CNS: Weakness, confusion, blurred vision, liver,
restlessness CV: tachycardia Legumes,
Collapse, • Nutritional status: yeast, and whole
pulmonary edema, beef, liver, whole or grains.
hypotension EENT: enriched grains, legumes •
Tightness Application of cold to help
of throat decrease injection site pain
GI: Hemorrhage, •Pregnancy/breastfeeding:
nausea, diarrhea considered compatible with
INTEG: pregnancy, breastfeeding
Angioneurotic Evaluate:
edema, cyanosis, • Therapeutic response:
sweating, warmth absence of nau- sea,
SYST: Anaphylaxis vomiting, anorexia,
insomnia, tachy- cardia,
paresthesias, depression,
muscle weakness

Medications: Depending on the severity of bleeding or the risk of preterm labor, medications

may be prescribed to control bleeding, manage pain, or prevent preterm birth. These medications

could include tocolytics to delay labor or corticosteroids to promote fetal lung development if

preterm birth is a concern.

SAN PABLO COLLEGES
COLLEGE OF NURSING

DRUG STUDY
 VII.NCP

SAN PABLO COLLEGES

COLLEGE OF NURSING

NURSING CARE PLAN

NURSING DIAGNOSIS: NURSING EVALUATION:

Anxiety related to may be related to INTERVENTIONS
perceived change in health status and NIC: Teaching
unknown etiology, as evidenced by Individual -Vital signs have
fear of unspecified consequences. remained stable or
Independent improved.

Rationale:
Due to mother’s vaginal bleeding on
her pregnancy, patient experienced
anxiety on what might happen to her
baby.
• Establish rapport. To gain -Maintained fluid
patient’s trust and have a good volume.
nurse-patient relationship.
-Vaginal bleeding has
• Monitored for any untoward signs been controlled.
and symptoms.

• VS taken and recorded

• Continuously monitor both the

Reference: mother and baby, using fetal heart
Nurse’s Pocket Guide rate monitoring and maternal vital
Diagnoses, Prioritized sign checks.
Interventions and Rationales
(11 Edition)
th

• Educating the patient about the

importance of bed rest and activity
restriction to reduce the risk of
bleeding.

• Therapeutic environment given.

IX.DISCHARGE PLANNING

Your doctor will keep a careful eye on you until your baby can be safely delivered. This might be

a difficult moment for you. If the placenta has shifted and no longer covers the cervix, a vaginal

delivery may be feasible. Most of the time, a cesarean section is required.

Follow-up care is a vital part of your treatment and safety. Make and keep all appointments, and

if you have any concerns, call your healthcare practitioner or the nurse advice line.

How can you care for yourself at home?

You may need to be on bedrest until the baby is ready to be born.

You may need a blood transfusion if you lose a large amount of blood

An amniocentesis (amnio) may be done to check your baby's lungs if you have a C-section date

planned.

Your baby may need to be delivered early.

Watch for any vaginal bleeding or signs of labor.

Follow your healthcare provider’s instructions about doing your routine activity or light exercise.

Always have a phone nearby in case you need to call for help.
Tell all healthcare providers who examine you that you must not have pelvic examinations

because you have placenta previa.

Do not put anything, such as tampons or douches, into your vagina. Use pads if you are bleeding,

and call your healthcare provider or nurse advice line.

Do not use tobacco or tobacco-like products, including cannabis, and other substances.

Do not drink alcohol.

When should you call for help?

You have severe or a continuous flow of vaginal bleeding.

You have sharp or severe pain in your belly or pelvis that does not get better or go away.

You feel faint or too weak to stand up.

Call your healthcare provider, midwife, or nurse call line now or seek immediate medical

care if:

You have a vaginal bleeding.

You have pain in your belly or pelvis.

You think that you are in labor or are having contractions of your uterus with or without pain (6

or more in 1 hour).
 You have a sudden trickle or gush of fluid from your vagina.

Watch closely for changes in your health, and be sure to contact your healthcare provider,

midwife, or nurse call line if you have any questions or concerns.

Nursing Theories

NURSING THEORIES

Florence Nightingale's Environmental Adaptation Theory

Particularly those sub-concepts, this Florence Nightingale hypothesis is extremely beneficial. According to

Nightingale, when one or more environmental factors are out of balance, the client must make more effort

to combat environmental stress. She wrote in her nursing notes, "Nursing is an act of utilizing the patient's

environment to assist in the recovery."

Hildeegard Peplau’s Interpersonal Theories

The need for a partnership between nurse and client is very substantial in nursing practice. This definitely

helps nurses and healthcare providers develop more therapeutic interventions in the clinical setting.

Through these, Hildegard E. Peplau developed her “Interpersonal Relations Theory” in 1952, mainly

influenced by Henry Stack Sullivan, Percival Symonds, Abraham Maslow, and Neal Elgar Miller.

Ida Jean Orlando’s Deliberative Nursing Process Theory

Incorporating mental health topics into a fundamental nursing curriculum is how Ida Jean Orlando built her

approach. She suggested that nurses test their hypotheses and analyses with patients before drawing

conclusions since "patients have their own meanings and interpretations of situations."

With the help of her theory, we will be able to readily see and treat the patient.